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This is VAERS ID 1694240

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History of Changes from the VAERS Wayback Machine

First Appeared on 9/17/2021

VAERS ID: 1694240
VAERS Form:2
Age:30.0
Sex:Male
Location:Texas
Vaccinated:2021-09-09
Onset:2021-09-09
Submitted:0000-00-00
Entered:2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 206A21A / 1 LA / SYR

Administered by: Pharmacy      Purchased by: ??
Symptoms: Dizziness, Erythema, Haematochezia, Pruritus, Urticaria

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? Yes
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? Yes
Hospitalized? No
Previous Vaccinations: Varicella (24 years old, Merck, Lot# K003421, 17 December 2014) and some years I react to the flu shot
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: Ceclor
Diagnostic Lab Data: Some years when I get the flu vaccine I get hives and itchy In December 2014 when I received the first of 2 doses I was red/hives, itchy and almost fainted
CDC 'Split Type':

Write-up: Itchiness, lightheaded, hives/red, blood in stool

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